02
Aug
07

911 USE OR ABUSE?

As people go through their day, I’m sure, like me, the last thing on their minds are being caught up in a medical or traumatic injury emergency and having to summon responders to help them.
That is just how EMS works. It is there when you need it but, pray God, you never, ever do!

Reading about the bridge collapse in Minnesota got me to thinking about that event from the perspective of the people who needed help and the Paramedics and other responders who arrived to assist them. Just think, one second you are driving your car across a bridge spanning the Mississippi river, a task you have done a million times over the past few years. You are heading home to relax with your family after a hard days work. When all of a sudden, your car violently shakes and begins falling towards the rowdy, roaring river water below. All around you, cars and people and items, that are not suppose to be flying through the air, are flying through the air. Your mind just can’t seem to grasp what the hell is going on. By the grace of God, you have survived the ordeal. But many folks around you are injured and need help. You wipp out your trusty cell phone and dial the three most important numbers in the world of emergency care, 911.

When you dial those three infamous numbers you do it with confidence knowing that on the other end of the phone are trained professionals waiting and willing to respond to help in this, or any other emergency. That is the way it works. You don’t have to think twice about getting help. Just pick up a phone and dial and people will arrive within minutes.

But if that wasn’t the case? What if, when you called for help the response from the emergency dispatcher was more along the lines of, “um, let me see sir. Let me see if I can find an ambulance that is available to assist you in your emergency.” Or, what if the response was more like, ” well Ma’am all of our emergency crews are busy a the moment. We’ll send someone your way as soon as we can, okay?” Of course, this is ridiculous and totally unacceptable. But what if, on the most tragic, scary day of your life, the people you rely on the most for help could not respond quickly and efficiently?

I am here to tell you that this is a real possibility. There are several elements that are affecting our ability to respond as quick as possible. Some of these reasons include political manipulation of response areas by county EMS managers and a very serious Paramedic shortage.

But the reason I have chosen to write about is the abuse of the 911 system. Of course people should not hesitate to call 911 in an emergency. In busy areas with a lot of population, the number of 911 calls for a pre-hospital medical crew (ambulance) will occasionally stretch the resources that are available. This is especially true when a large event like the bridge collapse occurs. All surrounding crews are focused on the big event and a lot of the regular 911 calls get a delayed response from squads father away.

Let’s take a look at just a normal response day and what can affect a medical crews response to your emergency. First and foremost, the number one abuser of the 911 system is, believe it or not, doctors offices. Here is why. Let’s say you have an elderly parent or grand parent living with you at home that you take care of. On this particular day, your elderly family member says they don’t feel good. You try to get specifics but they are stoic and tell you they’ll be alright, just leave them alone. They seem to be alert, breathing normally and their mental status appears normal to you. But you are concerned so you call their private physician to schedule an appointment for a check up. You tell the receptionist on the line exactly what is going on and what you want. The problem is the doctor can’t see your loved one for over a week. So the receptionist tells you, as she has been trained to do, to call 911 if you are concerned and don’t want to wait. You don’t feel that you have an emergency, but you are concerned, and the doctors office did tell you to call 911, so you call and an advanced life support medical crew is dispatched and arrives at your home in due time. They check out your elderly loved one and do not find any life threatening events but, as we are trained to do, suggest that the family member be taken to the hospital for further evaluation.

By the time the pre-hospital medical crew has performed all the appropriate assessment and treatment skills per local protocols, transported the patient, given a full report to the receiving hospital, restocked all of the supplies, gotten all the needed signatures and traveled back to their first due area, it has taken nearly two hours before they are finally back in service. During that two hour period, the community that this crew is serving is without their designated advanced life support ambulance. Was this an appropriate use of the pre-hospital emergency medical system?

I argue that it was not. I am not saying that this elderly patient should not have been assessed by a doctor either at the office or the hospital to rule out anything that might be going on. I am saying that this patient did not need an ambulance. There is a huge difference between, “I don’t feel good” and a medical emergency. The bottom line here folks is that Medics are trained to treat life threatening traumatic and medical conditions. Yes, we are trained very extensively in physical assessment for medical and traumatic problems. But we are not equipped to look past the life threats to see why a person doesn’t feel good today. That is the role of the doctors in the hospitals and offices with all the expensive machines. Of course when you call them and they can’t see you for a while they are going to tell you to call 911. They have to because if something bad happens and they don’t, you will most likely sue them.

Here is another very common scenario. You have a child, lets say he’s two years old. This child develops a fever. You give them the appropriate dose of Ibuprofen but the fever continues. You call the doctors office but, same story as before, the doctor cannot see the child for a couple of days or even a week. You are concerned because the child is lethargic and the fever is not going down. So you call 911 and the EMS crew arrives quickly. They assess the child and reveal that, yes, he is febrile. No immediate life threats present. Of course they are glad to transport the child to the hospital for further evaluation and you take them up on the offer. No harm, no foul, right?

Well what if, while the crew was assessing and transporting the child, a cardiac arrest occurred in their first due area? Now, an ambulance from a surrounding squad has to respond to the cardiac arrest which means a longer response time. Time is of the essences in a real emergency so this is an important consideration. What if, because the crew is now out of their normal coverage area, they get lost or cannot find the address of the arrest? This means that more time will laps before the much needed advanced life support is delivered to the cardiac patient. You see my point?

Allow me to dispel a popular myth about going to the hospital via an ambulance. You will not be seen faster by the ED doctor just because you arrive by ambulance. You will still have to wait your turn and fall behind patients who arrive after you but who have life threatening situations.

Please believe me when I say, I am not advocating not using 911. I am only saying that before you dial those important emergency numbers, please put your problem in the proper perspective. Do you really have an emergency? Please think of others who may have a real emergency while a crew is busy evaluating yours. When in doubt, especially with chest pain, accidents, respiratory problems or fainting, call 911. These are true, possibly life threatening, emergencies.

If you can safely drive your friend or loved one with a non-life threatening condition to the hospital, then do so. You’ll save them a large medical bill for the transport and you may help save someone else who is in the middle of an emergency.

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